What you need to know about relapse in bipolar disorder

Bipolar disorder causes people to experience intense mood swings – from manic highs to depressive lows. Not everyone experiences bipolar the same way, however, it is estimated that at least 75 per cent of people diagnosed with bipolar disorder will relapse, even when following a treatment plan. 

In bipolar disorder, a relapse is defined as the return of depression or a manic or hypomanic episode after a period of wellness. Sometimes it is possible to predict a relapse; often it is not. For many, the onset of a relapse seems to come out of the blue.

Research shows that those who live with bipolar II are more likely to relapse than those who live with bipolar I, and that it's far more common to relapse into depression than into mania or hypomania. It's important to remember that bipolar disorder is a complex and chronic illness, and that there is no shame in not being able to 'control' the possibility of a relapse.

The word 'relapse' is sadly fraught with negative connotations. Many people equate relapsing with failure, especially if they are doing everything 'right' to manage and monitor their illness yet experience an episode anyway. The sense of failure that often accompanies a relapse can be devastating – and make it even more challenging to form and follow a strategy to stay well.

How to help yourself or someone you love

It's important for people living with bipolar – or friends, family and carers in a supportive role – to understand that relapses will happen. It's perfectly possible to do all the right things, including eating well, exercising regularly and getting enough sleep, and still relapse. It's essential not to feel like you have failed or failed somebody else.

It is fair to say that most people with bipolar disorder will relapse at some point, whether they are on medication or not. With proper treatment, most people can get right back on track after experiencing a relapse.

"Even if they don't make sense now, it can come in useful in hindsight to identify your bipolar relapse triggers. Remember, like the seasons, all things are cyclical. Don't try to fight bipolar, just try to understand it."

– Anonymous, SANE Forums user.

Common bipolar relapse triggers

While the neurological causes of relapse are unknown, the best approach to preventing future episodes is knowing what activities may trigger a new episode of illness. Everyone's triggers are different – if you can learn to recognise yours or those of a loved one, it may be possible to prevent or minimise the intensity of a bipolar relapse.

Keep in mind that even with the best coping strategies in the world, you might not be able to stave off a relapse. It is crucial to create a stable environment that is less likely to lead to an episode but if one occurs, you must not interpret it as some sign of weakness.

The following tips may help with preventing or minimising the intensity of a relapse:

• Stick with your treatment plan – that means bipolar-specific medication and psychotherapy for most. 
• Make sleep a priority and try to reduce stress. 
• Work on maintaining positive relationships at home and at work. 
• Try to exercise regularly, even if it's just stepping out for a daily walk. 
• Eat a healthy diet and discuss any new supplement intake with a healthcare professional, as some alternative remedies can exacerbate bipolar symptoms or negatively interact with medication. 
• Be wary of consuming too much caffeine, and stay away from drugs and alcohol. 
• Buy dosage dispensers from pharmacies or use a calendar to stay on top of your medication.
• Get your blood levels checked regularly.  
• Look into cognitive behavioural therapy (CBT), which can help you stabilise your mood and keep your life on track.
• Draw on your support network. 
• Take a daily mind, body and soul inventory check. Bipolar disorder is a complex mental illness that needs to be monitored. Taking notice of any physical and behavioural changes may help you limit the severity of a relapse and possibly stop it before it starts.

At the first signs of a possible relapse, you should always speak to a doctor or psychologist. Avoiding a relapse isn't always possible, and seeking help is essential. Learn to identify your triggers and be mindful to avoid them where possible.

Remember to stay positive about the periods of stability and wellness rather than focusing on the occasional or decreasing relapses. Take kind, compassionate care of yourself. Living with bipolar disorder is often a bumpy road, so try connecting with others who understand and can relate to your experiences. Our SANE Forums are dedicated communities for people affected by mental illness – including friends, family and carers. They're safe, anonymous and moderated 24/7 by mental health professionals.

For more information about bipolar disorder, see SANE's Facts and Guides on bipolar disorder and the SANE Families, Friends & Carers Guide.